Background
Methods
Search strategy
Database: Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) <1950 to Present > Search Strategy: |
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1. exp Fasciitis, Plantar/ 2. (plantar* adj5 (heel* or fasciit*)).mp. 3. pain*.mp. 4. 2 and 3 5. ((plantar* adj5 fasciit*) or (spur* syndrome* adj5 (heel* or calcaneal*))).mp. 6. (pain* adj3 heel*).mp. 7. 1 or 4 or 5 8. (stretch* or conservative*).mp. 9. exp exercise movement techniques/or exp exercise therapy/or exp musculoskeletal manipulations/ 10. 18 or 9 11. 6 and 10 12. 7 or 11 13. 1randomized controlled trial.pt 14. controlled clinical trial.pt 15. randomized.ab 16. placebo.ab 17. drug therapy.fs 18. 1randomly.ab 19. trial.ab 20. groups.ab 21. randomised.ab 22. 18 or 15 or 19 or 21 or 14 or 20 or 13 or 16 or 17 23. (animals not (human and animals)).sh 24. 22 not 23 25. 12 and 24 |
Study selection
Data extraction and study quality assessment
The PEDro Scale | DiGiovanni et al [15] | Hyland et al [17] | Porter et al [14] | Radford et al [19] | Sharma et al [20] | Wynne et al [18] |
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1) Eligibility criteria were specified | YES | YES | YES | YES | YES | YES |
2) Subjects were randomly allocated to groups (in a crossover study, subjects were randomly allocated an order in which treatments were received) | YES | YES | YES | YES | YES | NO |
3) Allocation was concealed | YES | NO | NO | YES | NO | NO |
4) The groups were similar at baseline regarding the most important prognostic indicators | NO | YES | YES | YES | YES | NO |
5) There was blinding of all subjects | NO | NO | NO | YES | NO | NO |
6) There was blinding of all therapists who administered the therapy | NO | NO | NO | NO | NO | NO |
7) There was blinding of all assessors who measured at least one key outcome | NO | NO | NO | NO | YES | NO |
9) All subjects for whom outcome measures were available received the treatment or control condition as allocated or, where this was not the case, data for at least one key outcome was analysed by "intention to treat" | NO | NO | NO | YES | NO | NO |
10) The results of between-group statistical comparisons are reported for at least one key outcome | YES | YES | YES | YES | YES | YES |
11) The study provides both point measures and measures of variability for at least one key outcome | YES | YES | YES | YES | YES | NO |
TOTAL SCORE OUT OF 10 (question 1, not included in total score) | 4 | 5 | 4 | 8 | 5 | 2 |
Analysis
Results
Study characteristics
DiGiovani et al [15] | Hyland et al [17] | Porter et al [14] | Radford et al [19] | Sharma and Loudon [20] | Wynne et al [18] | |
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Recruitment | Patients with plantar fasciitis not responsive to previous conservative treatment | General Practitioner's surgeries and local gyms | Orthopaedic clinic | Local community (newspaper adverts) | Local community and university | Local community & physician referrals |
Clinical signs and symptoms | Maximal pain on palpation of plantar fascia origin. Diagnosis of plantar fasciitis by a Physician | Pain > 3/10 on initial weightbearing. Pain localised at the plantar heel | Pain localised at the plantar heel. Pain at worst on initial weight-bearing | Pain localised at the plantar heel. Pain at worst on initial weight-bearing | Diagnosis of plantar fasciitis by a Physician | Diagnosis of plantar fasciitis |
Sample size for each group | A: plantar fascia stretch (non weightbearing) n = 51 B: tendo Achilles stretch (weightbearing) n = 50 | A: Stretch (non weightbearing), n = 10 B: Calcaneal taping n = 11 C: No treatment (control) n = 10, D: Sham tape (Control) n = 10 | A: tendo Achilles sustained. stretch (weightbearing) n = 54 B: tendo Achilles intermittent stretch (weightbearing) n = 40 | A: Calf muscle stretch and sham ultrasound (weightbearing) n = 46 B: Sham ultrasound (Control) n = 46 | A: Stretching exercises (plantar fascia and tendo Achilles) n = 8 B: static progressive stretch ankle brace n = 9 | A: Counterstrain (non weightbearing) n = 10 B: Placebo non-steroidal anti-inflammatory (Control) n = 10 |
Mean age (SD, range) in years | A: 44.6 (23-60) B 47.1 (31-60) | A 34.1(5.9), B 45.5 (12.0), C 40.4 (9.4), D 37.6 (10.1) | A 45.4 (11.1) B 45.9 (12.1) | A 50.7 (11.8) B 50.1 (11.0) | A 40.3 (7.0) B 44.2 (11.3) | Mean not documented (20-66) |
Symptom duration. Number of subjects and mean duration or range and percentage if unavailable (months) | A: 20 (10-12), 4 (13-18), 1 (19-24), 9 (25-36), 12 (>36). B: 5 (10-12), 15 (13-18), 8 (19-24), 3 (25-36), 5 (>36) | Not documented | A: 54% > 6 B: (53%) > 6 | A Median 13 (4-610) B Median 13 (3-121) | A 9.2 (7.7) B 12.2 (6.4) | Not documented |
Previous conservative treatment n (%) | Not documented | Not documented | A 19 (35), B 17 (43) | Not documented | "Most" | Not documented |
Body Mass Index Mean (SD) | A 28.2, B 28.4 | A 26.3 (3.8), B 24.8 (4.4), C 25.4 (4.3), D 23.6 (1.7) | A 27.7 (5.8) B 29.2 (5.6) | A: 31.6 (5.8) B: 32.1 (6.5) | Not documented | Not documented |
Hours standing per day Mean (SD) | A: 6, B: 5.4 | Not documented | Not documented | A: 7.5 (5.5), B: 9.1 (3.7) | Not documented | Not documented |
DiGiovanni et al [15] | Hyland et al [17] | Porter et al [14] | Radford et al [19] | Sharma and Loudon [20] | Wynne et al [18] | |
---|---|---|---|---|---|---|
Follow up (weeks) | 8 | 1 (0 & 1) | 4 months (0, 1, 2, 3, and 4) | 2 weeks (0 & 2) | 12 (0, 4, 8 & 12) | 10 (0, 3, intervals to 8-10) |
Compliance | Exercise logs provided but not collected for analysis. Questioning: n = 1 in plantar fascia stretch group and n = 4 in Achilles stretch group stopped stretching at 8 weeks | All interventions applied by Therapist | Sustained stretching group: 74.5% (SD 18.4) of stretches completed. Intermittent group: 81.2% (SD 20.6) of stretches completed. p = 0.2175 | Daily journal kept by all participants. Details of compliance not stated | Not measured. | Not applicable as stretch applied by Therapist. |
Drop-outs | Overall 18.8% (n = 19). Plantar fascia stretching group 9.8% (n = 5). Tendo Achilles Stretching group 28% (n = 14). | Overall = 2% (n = 1). Group obtaining the drop-out not specified | Overall 21% (n = 28) Sustained stretching group 6.0% (n = 14). Intermittent stretching group 35.0% (n = 14). Control group 0% | 0% (n = 0) | Overall 24% (n = 4), Stretching 12.5% (n = 1), Splint 33% (n = 3) | Overall 5% (n = 1) Crossover trial therefore drop-out not specific to a single group |
Reasons for dropping-out | Not stated | Not stated | Requested injection or surgery. Unwilling to travel. Other medical disorders. (no break-down provided) | Not applicable | Not known. | Subject failed to record data fully, results therefore discarded. |
Reports of harmful effects | Not stated | No adverse effects from taping. No statement about stretching | Not stated | Stretching group: Increased heel pain (n = 4), Calf pain (n = 4). New lower--limb pain (n = 2). Control group: nil | None reported. | Not stated |
DiGiovanni et al [15] | Hyland et al [17] | Porter et al [14] | Radford et al [19] | Sharma and Loudon (2010) | Wynne et al [18] | |||
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Stretching Groups | A | B | A | B | ||||
Type of Stretch | Plantar Fascia. Thumb palpation of Plantar Fascia tension. | Tendo Achilles | Gastrocnemius/ Soleus Plantar Fascia by therapist | Tendo Achilles for 3 minutes | Tendo Achilles for 20 seconds | Tendo Achilles on step | Plantar Fascia stretches and massage. Tendo Achilles stretch | "Counter-strain" in position of 70-80% symptom relief of tender points. |
Applied by | Patient | Patient | Therapist | Patient | Patient | Patient | Patient | Therapist |
Duration of Stretch | 10 seconds | 10 seconds | 30 seconds | 3 minutes | 20 seconds | Not Described | 30 seconds | 90 seconds |
Frequency of Stretch | 10 reps, 3 × daily | 10 reps, 3 × daily | 3 reps on day 1, and 3 on day 4 | 1 rep, 3 × daily | 5 reps, 2 × daily | 5 minutes daily | 3 reps 3× daily | Not described |
Weightbearing/Non weightbearing | Non weight bearing | Weight bearing | Non weight bearing | Weight bearing | Weight bearing | Weight bearing | Non weight bearing and weight bearing | Non weight bearing |
Knee flexed or extended | Flexed | Extended | Flexed and Extended | Extended | Extended | Not described | Flexed and Extended | Not described |
Into/Out of Pain | "To feel stretch" | "To feel stretch" | Not described | Not described | Not described | Not described | Not described | Not described |
Supervised? | No | No | Not applicable | No | No | No | No | Not applicable |
Study quality
Effectiveness of stretching
Outcome | Group | Baseline score (+/- SD) | Follow up score (+/- SD) | Change in mean score (+/- SD if available) | Between group difference (p value) | |
---|---|---|---|---|---|---|
Hyland [17] | 10 point visual analogue scale | Stretching | 6.3 (0.8) | 4.6 (0.7) |
#-1.7 | |
at 1 week (0 = no pain) | Control | 6.3 (1.2) | 6.2 (1.0) |
#-0.1 | Versus stretching 0.026 | |
Sham taping | 6.4 (1.2) | 6.0 (0.9) |
#-0.4 | Versus stretching >0.05 | ||
Radford [19] | 100 mm visual analogue scale | Stretching | 70.9 (23.0) | 51.1 (29.1) | -19.8 (26.0) | 0.138 |
1st step pain at 2 weeks (0 = no pain) | Sham ultrasound | 75.8 (19.1) | 62.5 (29.5) | -13.2 (25.2) |
Outcome | Group | Baseline score (+/- SD) | Follow up score (+/- SD) | Change in mean score (+/- SD if available) | Between group difference (p value) | |
---|---|---|---|---|---|---|
Hyland [17] | Patient Specific Score | Stretching§
| 5.6 (1.1) | 4.9 (1.2) |
#-0.7 | 0.078 |
at 1 week | Control§
| 5.3 (1.5) | 4.8 (1.3) |
#-0.5 | ||
(10 = full function) | Sham taping | 5.3 (0.5) | 5.4 (0.6) |
#-0.1 | ||
Radford [19] | Foot Health Status Questionnaire | Stretching | 56.3 (24.5) | 72.4 (23.6) | 16.2 (19.5) | 0.052 |
at 2 weeks (100 = full function) | Sham ultrasound | 58.2 (24.0) | 66.4 (26.2) | 8.3 (18.5) |
Outcome | Group | Baseline score (+/- SD) | Follow up score (+/- SD) | Change in mean score (+/- SD if available) | Between group difference (p value) | |
---|---|---|---|---|---|---|
Hyland [17] | 10 point visual analogue | Stretching | 6.3 (0.8) | 4.6 (0.7) |
#-1.7 | 0.006 |
scale at 1 week | Calcaneal taping | 7.0 (0.8) | 2.7 (1.8) |
#-4.3 | ||
Sharma [20] | 10 point visual analogue | Stretching |
#5.3 ## (2.3) | 3.5 ## (3.0) |
#1.75 | Not stated |
scale at 4 weeks | Bracing |
#5.0 ## (0.8) | 3.75 ## (2.3) |
#1.25 | Not stated |
Outcome | Group | Baseline score (+/- SD) | Follow up score (+/- SD) | Change in mean score (+/- SD if available) | Between group difference (p value) | |
---|---|---|---|---|---|---|
Hyland [17] | Patient Specific Score at 1 week |
§Stretching | 5.6 (1.1) | 4.9 (1.2) |
#-0.7 | 0.078 |
(10 = full function) | Calcaneal taping | 4.5 (1.6) | 6.2 (1.8) |
#1.7 | ||
Sharma [20] | AOFAS ankle/hindfoot scale at 4 weeks | Stretching |
#64 ##(15) |
#65 ##(21) |
#1.0 | Not stated |
(100 = full function) | Bracing |
#64 ##(5.7) |
#65 ##(19.8) |
#1.0 |
Outcome | Group | Baseline Score (+/- SD) | Follow up score (+/- SD) | Change in mean score (+/- SD) if available | Between group difference (p value) | |
---|---|---|---|---|---|---|
Giovanni [15] | Pain (100 mm visual analogue scale) sub-scale of Foot Function Index (0 = no pain) | Weight bearing Achilles stretch | Not stated | Not stated | Pain at worst -14.7 ##(+/-19.9) 1st am steps -13.2 ##(+/-27.7) Combined pain score -13.0##(+/-20.8) | Pain at worst p = 0.02
#Mean 11.3 1st steps in morning p = 0.006
#Mean 17.9 Combined score p > 0.05
#Mean 6.0 |
Non weight bearing plantar fascia stretch | Not stated | Not stated | Pain at worst -26.0 ##(+/-24.3) 1st am steps -31.1 ##(+/-28.8) Combined pain score -19.0 ##(+/-19.9) | |||
Porter [14] | Foot and ankle pain score | Sustained | 57.5 (20.1) | 79.7 (17.5) |
#22.2 | P = 0.315 |
(100 = no pain) | Intermittent | 53.5 (22.0) | 82.5 (15.2) |
#29.0 |
Outcome | Group | Baseline score (+/- SD) | Follow up score (+/- SD) | Change in mean score (+/- SD) if available | Between group difference (p value) | |
---|---|---|---|---|---|---|
Giovanni [15] | Function Index | Weight bearing, Achilles stretch | Not stated | Not stated | -8.3 ##(16.6) | 0.058 |
(0 = full function) | Non weight bearing, plantar fascia stretch | Not stated | Not stated | -19.6 ## (18.7) | ||
Porter [14] | Foot and ankle function score | Sustained | 68.8 (19.9) | 82.5 (18.7) |
#13.7 | |
(100 = full function) | Intermittent | 62.3 (19.7) | 88.5 (14.2) |
#26.2 | >0.05 |